<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Channels_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-channels_id" data-rule="required" data-source="channels/index" class="form-control selectpage" name="row[channels_id]" type="text" value="{$row.channels_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Register_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-register_num" class="form-control" name="row[register_num]" type="number" value="{$row.register_num|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_num" class="form-control" name="row[pay_num]" type="number" value="{$row.pay_num|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sign_up_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sign_up_num" class="form-control" name="row[sign_up_num]" type="number" value="{$row.sign_up_num|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
